A remarkable operation for producing anaesthesia, daring in its conception and brilliant in its results, was performed at St Vincent’s hospital in Indianapolis last week. The operation consists of injecting into the spinal canal (a cavity heretofore held sacred from the surgeon’s invasions) a 2 percent solution of cocaine, or similar drug, with the result that within a few minutes the sense of pain from the level of the diaphragm down is entirely obliterated.
Legs may then be cut off, appendixes removed and other formidable operations done while the patient remains wide awake and perfectly conscious, but feel ing not the slightest twinge of pain. The marvelous advances made in surgery may be generally attributed to two discoveries: (1) anaesthesia, whereby the patient is relieved of pain by a blessed temporary unconsciousness, and (2) asepsis, whereby the healing of wounds “by first intention” and the prevention of suppuration and so-called “blood poisoning” have made it possible for the surgeon to invade even the head, the chest and the abdomen with impunity.
Anesthesia, as produced by chloroform find ether, has been before the public so long that every one is more or less familiar with it. But within the past two years, this method of nullifying pain has been introduced to the medical profession and is spreading rapidly in favor.
An Indianapolis surgeon, who has had considerable experience in surgical cases with this new method of anaesthesia, made the following statements to a Sunday Sentinel reporter:
“The credit for first proposing the injection of cocaine into the spinal canal belongs to Dr Corning of New York, who reported some experimental work on animals back in 1886. (Dr Corning, by the way, is the son of the Rev Mr Corning, for many years pastor of the First Congregational church of Terre Haute and who has on several occasions appeared before Indianapolis audiences.)
“Not until 1900, however, was the attention of the medical profession strongly called to it, when Tuffler, a Parisian surgeon, reported 130 cases to the international congress.
“Since that time, it has been considerably used in the larger cities of this country, and to a very limited extent in Indianapolis.
“A short time ago, a citizen of Indianapolis sustained a crushing injury of the leg, necessitating amputation at the knee joint. He was in such a weakened condition that it was feared that putting him under the influence of chloroform or ether would mean putting him through the portals of the tomb. Consequently, this newer method of abolishing the pain was tried. Twelve drops of a 2 percent solution of hydrochlorate were injected through a specially-prepared needle into the spinal canal below the level of the spinal cord. In five minutes, the patient was insensible to any pain whatsoever, below the level of the diaphragm.
“All the time his leg was being cut off and the stump sewed up, he was perfectly free from the slightest pain, talked unconcernedly with the assistants, and had he not been blindfolded, would have witnesed the operation himself. Moreover, although the sensory nerves were deadened, yet the power of motion remained unimpaired, and the patient shifted the position of his leg from time to time, whenever the surgeon found it would facilitate the operation. He was carried back to bed at the conclusion of the operation and stated he had felt no pain, although he had been conscious the entire time.
“There have been reported two cases of Caesarean section done under spinal anaesthesia, and with much better results than are obtained when chloroform or ether are employed.
“The region of the spine on a level with the upper edge of the pelvic bones. is sterilized with as much care as would be employed in an abdominal operation. The instruments, consisting merely of a hypodermic syringe with a short-bevelled needle three inches long, are also made thoroughly aseptic.
“The patient sits up and throws the body forward between the knees, lowering the back as much as possible, and thus making the greatest space possible between the spines of the vertebrae. The needle, minus the syringe, is then introduced in an upward and inward direction at a point between the fourth and fifth lumbar vertebrae, or just on a level with the tops of the large wing bones of the pelvis.
“After pushing the needle into their skins, muscles and ligaments for about two inches, a sudden cessation of resistance shows that the point is within the spinal canal, and upon removal of the finger from the outer end of the needle, the escape of a few drops of the cerebrospinal fluid which bathes the cord confirms the fact.
“The syringe is now attached to the needle, and between twelve and eighteen drops of a 2 percent solution of sterilized eucaine, cocaine or tropacocaine was slowly injected, taking a full minute for the process. The needle is then quickly withdrawn and the puncture sealed up.
“In average cases, numbness begins in the toes in three minutes, and in fifteen minutes sensation of pain is lost entirely, while sensation of touch and the power of motion are not affected, and all the while the patient is fully conscious. The surgeon may then remove a toe or a leg, amputate an appendix, stitch up the intestines or remove a tumor with out the patient’s feeling any pain whatsoever.
“The effects of this injection last from one to four hours, with an average of about three. If necessary to complete a very long and tedious operation, the injection may be repeated when the effects of the first begin to wear off.
“The patient may eat a hearty meal, and generally wants to, immediately upon being put to bed after the operation is completed; a thing which no one feels like doing for a day or two after taking chloroform or ether, as those who have taken them will readily testify.
“Spinal anasthemia will never supplant the older anesthetics entirely. It cannot be used as a rule in operations above the diaphragm; and nervous patients would prefer the blessed oblivion which the general anesthetic gives. But it will find for itself a well-defined sphere in operations on the lower limbs and many abdominal cases, particularly in such patients to whom on account of bad heart, lungs, kidneys or arteries, chloroform and ether would be too dangerous.
“Many cases which the surgeon declines to operate upon because the heart is too weak to stand a general anesthetic can be safely handled by this method of spinal narcosis.
“Or course, like everything else, it has its disadvantages, among which might be mentioned the headache and nausea which accompany a certain percentage of cases.
“And some object on the ground that cocaine is a dangerous drug, even in such weak solutions as 2 percent. But later experimenters state, and this has been my own experience, that by the use of tropacocaine, even these bad features are eliminated.
“My own experiece covers confinement cases, amputations, abcesses and plastic operations, and so satisfactory has it been that I have adopted it wherever its use is in any way feasible.”
